动物造模,药效评价 z-bio 2024-09-02 429

　　In the past decade, laparoscopic technology in urology has developed rapidly and its application scope has significantly expanded. Up to now, a situation has been formed where destructive surgery is the main focus and reconstructive surgery is equally emphasized. Due to the high technical requirements, difficulty, and complexity of laparoscopic reconstructive surgery, such surgeries as pyeloplasty, radical prostatectomy, and radical cystectomy can currently only be performed in a few medical centers. Both mastering laparoscopic techniques and improving operational skills require sufficient in vitro simulation training. For complex reconstructive surgeries, a comprehensive and effective simulation should have realistic anatomical structures and adjacent relationships, real-time operational and visual spatial sensation of simulated surgery, and realistic tactile feedback. There are currently two main types of in vivo models that can meet these requirements, namely live animal models and surgical cadaver simulations. In order to simulate laparoscopic pyeloplasty in vivo, shorten the learning curve of actual surgery, and reduce the chance of intraoperative complications, Fu Bin et al. designed a miniature pig model for simulating and training laparoscopic pyeloplasty.

　　A small pig with a body weight of about 25kg was selected as the experimental model, and general anesthesia was given with rapid sleep (0.1ml/kg). During the operation, pentobarbital sodium (0.25g/kg) was used as needed to maintain anesthesia. After successful anesthesia, the pig is placed in a supine position and fixed on the operating table. Insert an pneumoperitoneum needle through the navel and inject CO2 to prepare an pneumoperitoneum. Use an pneumoperitoneum machine to maintain the intra-abdominal pressure at 15-17 mmHg. Then change the position to 900 lateral position, place a 12mm laparoscopic trocar next to the rectus abdominis muscle at the navel level, and insert two additional trocar tubes at positions 12-15cm above and below the axillary line. Sharp and blunt separation expose the kidney, free the renal hilum and ureter, and pay attention to maintaining the normal anatomical position of the kidney. Oblique dissection of the ureter, with a longitudinal incision of approximately 1.5cm along the dorsal side of the ureter. Select a segment of the small intestine near the renal hilum to replace the dilated renal pelvis. Suture the intestinal wall and the inner part of the upper pole of the kidney with 1-2 stitches to fix the intestinal tube on the inner side of the renal hilum, and then make a circular incision in the lower part of the small intestine near the distal end of the ureter to simulate cutting and dilating the renal pelvis. The renal pelvis ureteral anastomosis technique and ureteral stent placement method fully simulate the standard steps of laparoscopic pyeloplasty. In short, the first step is to suture the lowest point of the incised "renal pelvis" with the lowest point of the ureteral incision to provide fixation and prevent ureteral torsion. Continuously suture the posterior wall of the renal pelvis and ureter, and add a locking edge every 2-3 stitches. The remaining "renal pelvis" incision is closed by continuous or intermittent suturing. Then, a 6F or 4.5F double-J tube is placed antegradely into the ureter through the "renal pelvis" ureteral anterior wall anastomosis, with the proximal curved portion of the double-J tube inserted into the renal pelvis. Finally, intermittently suture and close the anastomosis of the anterior wall of the renal pelvis and ureter. All stitches and knots are completed inside the body. The second and third pyeloplasty on the same side of the kidney and ureter both start from separating and cutting the sutured "renal pelvis ureteral junction", and pulling out the ureteral stent tube from the anastomotic site. The remaining surgical steps are the same as before. In the same way, three pyeloplasty procedures were performed on the contralateral kidney ureter. Research has confirmed that this model can simulate the various technical requirements for laparoscopic pyeloplasty and enable students to master the intracavitary operation skills and surgical methods of pyeloplasty, thereby shortening the operation time